BILL ANALYSIS Ó
SENATE COMMITTEE ON EDUCATION
Carol Liu, Chair
2013-2014 Regular Session
BILL NO: SB 1266
AUTHOR: Huff
AMENDED: March 24, 2014
FISCAL COMM: Yes HEARING DATE: April 2, 2014
URGENCY: No CONSULTANT:Lynn Lorber
NOTE : This bill has been referred to the Committees on
Education, Health, and Judiciary. A "do pass" motion should
include referral to the Committee on Health.
SUBJECT :Epinephrine auto-injectors.
SUMMARY
This bill removes the authority, and instead requires, school
districts and county offices of education to provide emergency
epinephrine auto-injectors to trained personnel to provide
emergency medical aid to a person suffering from an
anaphylactic reaction.
BACKGROUND
Current law:
1) Authorizes a school district or county office of education
to provide emergency epinephrine auto-injectors to trained
personnel, and authorizes trained personnel to use an
epinephrine auto-injector to provide emergency medical aid
to a person suffering from an anaphylactic reaction.
2) Authorizes public schools to designate at least one school
personnel on a voluntary basis to receive initial and
annual training, based on specific standards, regarding
the storage and emergency use of an epinephrine
auto-injector.
3) Authorizes a school nurse, or if the school does not have
a nurse, a person who has received training, to:
a) Obtain a prescription for epinephrine
auto-injectors from the school district physician,
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medical director of the local health department, or
local emergency medical services director.
b) Immediately administer an epinephrine
auto-injector to a person exhibiting potentially life
threatening symptoms of anaphylaxis at school or a
school activity when a physician is not immediately
available.
4) Requires a school district or county office of education
electing to use epinephrine auto-injectors for emergency
medical aid to create a plan to address all of the
following issues:
a) Designation of the person(s) who will provide
the training.
b) Designation of the school district physician,
medical director of the local health department or
local emergency medical services director who will be
consulted for the prescription for epinephrine
auto-injectors.
c) Documentation as to who will obtain the
prescription and the medication.
d) Documentation regarding where the epinephrine
auto-injector is stored and how the epinephrine
auto-injector will be made readily available in case
of an emergency.
5) Requires the Superintendent of Public Instruction to
develop minimum standards of training, and requires the
training to include all of the following:
a) Techniques for recognizing symptoms of
anaphylaxis.
b) Standards and procedures for the storage and
emergency use of epinephrine auto-injectors.
c) Emergency follow-up procedures, including
calling 911 and contacting, if possible, the
student's parents and physician.
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d) Instruction and certification in cardiopulmonary
resuscitation.
e) Written materials covering the information
described above. (Education Code § 49414)
Current law also authorizes, in the absence of a credentialed
school nurse or other licensed nurse onsite at the school,
non-medical school personnel to administer medication to a
pupil in an emergency, after receiving specified training:
1) Glucagon may be administered to students with diabetes
suffering
from severe hypoglycemia. (EC § 49414.5)
2) Emergency anti-seizure medication may be administered to
students with epilepsy suffering from seizures. (EC §
49414.7)
ANALYSIS
This bill removes the authority, and instead requires, school
districts and county offices of education to provide emergency
epinephrine auto-injectors to trained personnel to provide
emergency medical aid to a person suffering from an
anaphylactic reaction. Specifically, this bill:
1) Removes the authority, and instead requires, school
districts and county offices of education to provide
emergency epinephrine auto-injectors to trained personnel,
and requires trained personnel, to the extent feasible, to
use the epinephrine auto-injectors to provide emergency
medical aid to people suffering from an anaphylactic
reaction.
2) Removes the authority, and instead requires, every public
school to designate at least one school staff, on a
voluntary basis, to receive initial and annual refresher
training regarding the storage and emergency use of an
epinephrine auto-injector. The training is to be provided
by the school nurse or other qualified person designated
by the school district physician, the medical director of
the local health department, or the local emergency
medical services director.
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3) Removes the authority, and instead requires a school
nurse, or if the school does not have a school nurse, a
person who has received training to do the following:
a) Obtain a prescription for epinephrine
auto-injectors.
b) Immediately administer an epinephrine
auto-injector to a person exhibiting potentially
life-threatening symptoms of anaphylaxis when a
physician is not immediately available.
4) Adds school district administrators to trained non-medical
personnel who are required to obtain a prescription and
administer an epinephrine auto-injector. This bill
expands the circumstances under which trained non-medical
personnel are required to obtain a prescription for and
administer an epinephrine auto-injector to include
situations when a school has a nurse but the nurse is not
onsite or available.
5) This bill adds the requirement that the prescription is to
include, at a minimum, one adult and one junior
epinephrine auto-injector. This bill expands the list of
entities from which the prescription is to be obtained to
include a physician contracting with the school district,
and authorizes the prescription to be filled by local or
mail order pharmacies or epinephrine auto-injector
manufacturers (see #11).
6) Requires the Superintendent of Public Instruction (SPI) to
review, every five years, or sooner as deemed necessary by
the SPI, the existing minimum standards of training for
the administration of epinephrine auto-injectors.
7) This bill requires the epinephrine auto-injector to be
restocked once it is used, and requires expired
epinephrine auto-injectors to be restocked before their
expiration date.
8) Requires, no later than 30 days after the last day of each
school year, the school nurse or designated employee to
report any use of an epinephrine auto-injector to the SPI
on a form developed by the SPI, and requires the SPI to
annually post this information on the Internet without
violating federal and state privacy laws.
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9) Requires the training to be consistent with the most
recent Voluntary Guidelines for Managing Food Allergies In
Schools and Early Care and Education Programs published by
the federal Centers for Disease Control and Prevention,
and with the most recent guidelines for medication
administration issued by the California Department of
Education.
10) Adds the following entities to the list of those that the
Superintendent of Public Instruction is required to
consult in the review of the training standards:
a) Food Allergy Research and Education.
b) The California Society of Allergy, Asthma and
Immunology.
c) The American College of Allergy, Asthma and
Immunology.
11) Deletes prohibition on the receipt of state funds for
costs associated with the prescription, training, and
reporting, and specifically authorizes schools to accept
gifts, grants, and donations from any source including,
but not limited to, the acceptance of epinephrine
auto-injectors from a manufacturer or wholesaler.
STAFF COMMENTS
1) Requiring a volunteer . This bill currently requires
school districts and county offices of education to
designate at least one school personnel who volunteers to
receive training, and requires a person trained in the use
of an epinephrine auto-injector to immediately administer
it to a person exhibiting potentially life-threatening
symptoms of anaphylaxis.
The author wishes to amend this bill to reinstate the existing
authority for school personnel who volunteer to be trained
to administer an epinephrine auto-injector. This
addresses concerns about requiring unlicensed, non-medical
personnel to administer medication, which imposes a high
standard on volunteers.
2) Role of school administrators . This bill adds school
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district administrators to the list of trained non-medical
personnel who are required to obtain a prescription and
administer an epinephrine auto-injector. The author
wishes to amend this bill to authorize, rather than
require, a school nurse, or school administer or other
designated personnel who has received training, to
administer an epinephrine auto-injector (this bill would
still require a school nurse, or schoolsite administer or
other designated school personnel who has received
training, to obtain the prescription). This ensures that,
in situations where no one volunteers to be trained, the
schoolsite administrator must be trained, required to
obtain the prescription and is authorized to administer an
epinephrine auto-injector in an emergency.
3) Liability . Recent amendments to this bill deleted
language providing that the school district, county office
of education, and trained personnel shall not be liable
for any civil damages resulting from the administration of
an epinephrine auto-injector to a person reasonably
believed to be suffering from an anaphylactic reaction.
The author wishes to amend this bill to insert provisions
relative to liability that currently exist in statute
regarding the administration of emergency anti-seizure
medication, as follows:
A school district, county office of education, or
charter school, shall ensure that each employee who
volunteers under this section will be provided
defense and indemnification by the school district,
county office of education, or charter school for any
and all civil liability, in accordance with, but not
limited to, that provided in Division 3.6 (commencing
with Section 810) of Title 1 of the Government Code.
This information shall be reduced to writing,
provided to the volunteer, and retained in the
volunteer's personnel file.
4) How many schools have a nurse ? California's
nurse-to-pupil ratio is approximately 1:2,200. According
to the California Basic Educational Data System, about
one-half of school districts do not have a school nurse.
In those areas, the county office of education should
provide a nurse but it is possible that no nursing
coverage exists for some school districts.
This bill expands the circumstances under which trained
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non-medical personnel are required to obtain a
prescription for, and authorized to administer, an
epinephrine auto-injector to include situations when a
school has a nurse but the nurse is not onsite or
available. Some schools have a school nurse but only on a
part-time basis.
5) School staff currently administering medication . No data
is maintained by the State as to the number of school
districts that choose to allow staff to receive training
to administer, or assist with the administration of,
medication to pupils.
6) Training . This bill adds the requirement that the
prescription is to include, at a minimum, one adult and
one junior epinephrine auto-injector. Staff recommends an
amendment to include in the training a component relative
to the determination of using an adult or junior dose
epinephrine auto-injector.
7) Technical amendments . This bill requires, in compliance
with federal and state privacy laws, the Superintendent of
Public Instruction (SPI) to annually publish the results
of the submitted forms on his or her Internet Web site,
Staff recommends the following amendments:
a) Strike references to the SPI and instead
reference the California Department of Education
(CDE).
b) Require schools to report to the school district
or county office of education, and require the
district or county office to report to the CDE
(rather than requiring schools to report directly to
the CDE).
c) Clarify that the information is to be posted on
the Internet without violating federal and state
privacy laws (current language could imply that
posting information on the Internet is required for
compliance with privacy laws).
This bill imposes requirements upon school districts and
county offices of education, but does not specifically
include charter schools. Staff recommends an amendment to
specifically include charter schools in the application of
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this bill.
This bill requires expired epinephrine auto-injectors to
be restocked before their expiration date. Staff
recommends an amendment to strike the word "expired" to
further clarify that epinephrine auto-injectors are to be
restocked before their expiration date.
SUPPORT
Allergy & Asthma Associates of Southern California
Allergy & Asthma Medical Group & Research Center
Allergy and Asthma Associates of Northern California
American College of Emergency Physicians
Asthma and Allergy Foundation of America
California Society of Health-System Pharmacists
Capital Allergy & Respiratory Disease Center
Children's Hospital Los Angeles
Food Allergy & Anaphylaxis Connection Team
Food Allergy Research & Education
Lucille Packard Children's Hospital
Mercy Medical Group
San Diego Food Allergy
The Allergy Station
Numerous individuals
OPPOSITION
California Federation of Teachers